Objectives: Evidence determining the optimal treatment for cardiac tumors is rare. We report our mid-term clinical outcome and patient characteristics of our series undergoing atrial tumor removal through a right lateral mini-thoracotomy (RLMT).

Methods: From 2015 to 2021, 51 patients underwent RLMT for atrial tumor extirpation. Patients receiving concomitant atrioventricular valvular, cryoablation and/or PFO-closure surgery were included. Follow-up was performed using standardized questionnaires (mean FU-length 1041±666 days). Follow-up involved any tumor recurrence, clinical symptoms, and any recurrent arterial embolization. Survival analysis was successfully achieved in all patients.

Results: Successful surgical resection was achieved in all patients. Mean CPB- and X-clamping time was 75±36 and 41±22 minutes, respectively. Most common tumor location was the left atrium (42 (82.4%)). Mean ventilation time was 12.74±17.23 hours, ICU stay ranged from 1 to 1.9 days (median 1 day). Nineteen (37.3%) patients received concomitant surgery. Histopathological analysis showed 38 (74.5%) myxoma, 9 (17.6%) papillary fibroelastoma and 4 (7.8%) thrombus. Thirty-day mortality was observed in 1 (2%) case. One patient (2%) suffered a stroke postoperatively. No patient (0%) had a relapse of cardiac tumor. Three (9.7%) patients showed arterial embolization during follow-up. Thirteen (25.5%) follow-up patients were in NYHA class ≤ II. Overall survival was 90.2% at 2 years.

Conclusions: A minimally invasive approach for benign atrial tumor resection is effective, safe and reproducible. Thirty-eight (74.5%) of the atrial tumor were myxoma and 87% of them were located in the left atrium. A low 30-day mortality rate with no manifestation of recurrent intracardiac tumor was observed.